ADVANTAGES AND LIMITS OF CONVENTIONAL MED IASTINOSCOPY IN PREOPERATIVE STAGING OF PRIMARY LUNG-CANCER

Purpose of the study: Retrospective evaluation of conventional mediast inoscopy in the preoperative staging of primary lung cancer. Methods: Between 1978 and March 1997, 117 consecutive patients underwent conven tional mediastinoscopy in the preoperative staging of primary lung can cer, after imaging had shown mediastinal lymph nodes larger than 1.5 c m. Results: In 8 instances no material was found at mediastinoscopy, i n 38 the lymph nodes showed no tumorous infiltration, and in 71 the ly mph nodes were metastatic. 48 patients underwent thoracotomy in the sa me stage, with resection achieved in 41. Contraindications for thoraco tomy (in 69) were N2 (45) or N3 (11) disease and/or small cell lung ca ncer (18). Mediastinal lymphadenectomy was performed in 26 of the 41 p atients who underwent lung resection; half of those with negative node s at mediastinoscopy had in fact N2 disease, with involvement of 2 are as or more in half. There were no deaths due to mediastinoscopy but 4 complications. Conclusions: A favorable mediastinoscopy is not synonym ous with resectable disease, nor does it exclude N2 disease; it does h owever serve to avoid unnecessary thoracotomies in more than half of c ases.